Solemn Declaration

Company Letterhead

{{company_name}}

{{company_address}}

Phone: {{phone}}

Email: {{email}}

Website: {{website}}

Date

{{date}}

Subject: Solemn Declaration by Employee

I, {{employee_full_name}}, with employee ID {{employee_id}}, residing at {{employee_address}}, and holding the position of {{employee_position}} at {{company_name}}, do hereby solemnly and sincerely declare as follows:

Declaration Statement

1. That {{declaration_statement_1}}.

2. That {{declaration_statement_2}}.

3. That {{declaration_statement_3}}.

4. That I make this solemn declaration conscientiously believing the same to be true, and by virtue of the provisions of the Declarations Act [or equivalent local statute, e.g., Oaths and Declarations Act in Kenya, Justices of the Peace and Commissioners of Oaths Act in South Africa].

Purpose of Declaration

This declaration is made for the purpose of {{purpose_of_declaration}} and to be submitted to {{recipient_department_or_person}}.

Undertaking

I understand that any false declaration made herein may subject me to disciplinary action by {{company_name}}, and potentially to legal penalties as provided by law.

Signature Block

Declared at {{city}}, this {{day}} day of {{month}}, {{year}}.

___________________________

{{employee_full_name}}

Employee Signature

Witnessed by:

___________________________

{{witness_full_name}}

{{witness_position}}

Signature of Witness